The Clifton Practice Hypnotherapy Training

Student Application Form

Please print out and complete this form
All applicants for the classroom programme will be required to participate in a brief interview, after submitting this completed form. This will take place at The Clifton Practice. This also gives you an opportunity to ask any questions you may have and to meet David Newton. We will contact you to arrange it.

Application date ..................................
Full name ......................................................................................
Address ......................................................................................
......................................................................................
Post code ..................................
Telephone ..................................
E-mail ......................................................................................
Date of birth ..........|...........|..........

Please tick which course you are applying for:
  Classroom Course : Intake 42 May 10/11 2008 Full
  Classroom Course : Intake 43 Sept 6/7 2008
  Small Group Course : Intake 42a

How do you wish to pay?

A deposit of 10% is required with this application i.e. £195 for classroom students. After the interview, this then becomes your first months payment.

I have enclosed payment of: £.................... by [ ] cheque [ ] bank draft (payable to ‘The Clifton Practice')

[ ] I wish to pay the deposit by credit / debit card.

Number ............................................................................
Valid from ..................................
Expires end ..................................
Issue number ..................................

I understand that if I am not accepted as a student for any reason
whatsoever, or I decide after the interview not to go ahead, any money
I have paid will be refunded in full.

Signature ......................................................................................

Please submit completed form to:
The Clifton Practice, 8-10 Whiteladies Road, Bristol BS8 1PD, England.

Application date	..................................
Full name	......................................................................................
Address	......................................................................................
	......................................................................................
Post code	..................................
Telephone	..................................
E-mail	......................................................................................
Date of birth	..........\|...........\|..........

Number	............................................................................
Valid from	..................................
Expires end	..................................
Issue number	..................................